PHM-Exch> DRAFT Alternative Civil Society Astana Statement on Primary Health Care

[Claudio Schuftan]

*DRAFT Alternative Civil Society Astana Statement on Primary Health Care*



*(Please note, after some consultation it was agreed to call this a
“statement” rather than a “declaration”. The statement is a re-affirmation
of the Alma Ata declaration, which to PHM and others remains the ultimate
declaration on primary health care; the principles are clear and remain
relevant. This statement can be seen as a re-commitment to the Alma Ata
declaration of 1978: a number of points have been drawn out from the Alma
Ata Declaration; with a few additions relevant to the current context and
challenges. Although the title has changed, the content remains the same)*



We, members of public interest civil society organisations and social
movements, some of whom are participants at the Global Conference on
Primary Health Care, re-affirm our commitment to primary health care (PHC)
in pursuit of health and well-being for all, aiming to achieve equity in
health outcomes. We envision:



Societies and environments that prioritize, protect and promote people's
health;

Health care that is accessible, affordable and acceptable for everyone,
everywhere;

Health care of good quality that treats people with respect and dignity;

Health systems over which communities are able to exert control



Although these objectives are shared in the official Astana Declaration
(version 16th August 2018) it is concerning that the latter frames PHC
primarily as a foundation of Universal Health Coverage (UHC). PHC, is
broader and indeed subsumes UHC, which is, in many countries, being
implemented by private health insurance companies and aggravating health
inequities. Additionally, the official declaration (version 16th August) is
insufficiently clear that governments have primary responsibility for
health service delivery and for ensuring that social determinants maximise
health and equity. While the official declaration recognises “that people
in all parts of the world have unaddressed health needs and inequities
persist”, it does not acknowledge that health gains in some places are
being reversed. These issues and their fundamental economic and political
causes which are responsible for widening inequalities worldwide need to be
more explicitly stated. These are some of the reasons why People’s Health
Movement and its constituency feel it necessary to elaborate an Alternative
Statement.



Attaining the highest possible standard of health is a fundamental right of
every human being, as stated in the Constitution of the World Health
Organization. Forty years ago, in 1978, world leaders made the historical
commitment to achieve health for all through Primary Health Care in the
Declaration of Alma-Ata. We, the undersigned, express the need for urgent
action by all international agencies and governments, all health and
development workers, and the world community to protect and promote the
health of all the people of the world, hereby makes the following
Statement:

1.     We the undersigned strongly reaffirm that health, which is a state
of complete physical, mental, social, cultural, and ecological wellbeing,
and not merely the absence of disease or infirmity, is a fundamental human
right and that the attainment of the highest possible level of health is a
most important world-wide social goal whose realization is the
responsibility of governments and requires the action of many other social
and economic sectors in addition to the health sector. People’s health
depends on working and living conditions that promote flourishing lives and
a healthy and protected natural environment.



2.     The existing extreme and growing inequality in the economic and
health status of the people both across the world, as well as between and
within countries is politically, socially, economically and ethically
unacceptable and a source of conflict and environmental destruction and is,
therefore, of common concern to all countries.



3.     Equitable economic and social development, will require rejection of
the currently dominant neo-liberal paradigm and establishment of a
sustainable and equitable economic order globally and nationally. Amongst
other interventions regulation of financial flows and of tax havens and
evasion are urgently needed. These changes, along with recognition and
action to address inequities due to gender, caste, race, disability and
sexual orientation, are of basic importance to the fullest attainment of
health for all and to the reduction of the gap in the health status within
and between countries. The promotion and protection of the health and
wellbeing of all people will enable sustainable and equitable forms of
social and economic development that will contribute to world peace and
environmental protection.



4.     The people should be afforded every opportunity to participate
individually and collectively in the planning and implementation of their
health care. This participation should respect age, gender, ethnicity and
socio-economic status and use digital technologies where appropriate.



5.     Governments have a responsibility to realise the right to health of
their people along with other rights specified in the United Nations (UN)
Declaration of Human Rights. A main social target of governments,
international organizations and the whole world community in the coming
decades should be the attainment by all peoples of the world of a level of
health that will permit them to lead socially and economically flourishing
lives. The United Nations SDGs could be important in reaching this target
if they are underpinned by the establishment of a global and national
equitable and sustainable economic order. Primary health care is the key to
attaining Health for All as part of development in the spirit of social
justice, and which is eminently possible given current knowledge,
technology and resources.



6.     Effective and accountable global governance for health is required
to realise PHC. This should include means of effective taxation to ensure
that all individuals and corporations pay their fair share of taxes to
enable the funding of health and other services beneficial to health;



7.     By 2018 the survival of life on earth is threatened by accelerating
climate change. Thus part of the PHC approach should be to endorse the
Earth Charter (2000) which proposed we are all citizens of our planet as
well as our nation states. It recognised the interconnections between
living in harmony with and protecting the natural environment and other
species, and living in peace, with equity and social justice within human
societies; all core parallel principles shared with the Primary Health Care
movement.



8.     Primary health care is essential health care based on practical,
scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community through
their full participation in the spirit of self-determination. It forms an
integral part both of the country's health system, of which it is the
central function and main focus, and of the overall social and economic
development of the community. It gives particular emphasis to the household
and community levels and the first level of care bringing comprehensive
health care as close as possible to where people live and work, and is
fully integrated with other levels of care.



9.     Primary health care:

       I.         reflects and evolves from the economic conditions and
sociocultural and political characteristics of a country and its
communities and is based on the application of relevant social, biomedical
and health systems research and public health experience;

      II.         addresses the main health problems in the community,
providing promotive, preventive, curative, rehabilitative and palliative
services accordingly;

     III.         includes at least: health education concerning prevailing
health problems and the methods of preventing and controlling them;
promotion of a healthy food supply and proper nutrition; an adequate supply
of safe water and basic sanitation; reproductive  and sexual  health care,
including maternal health care, contraception, abortion;  prevention and
health care for gender based violence; child health care,; immunization
against the major infectious diseases; prevention and control of locally
endemic diseases and non-communicable disease including mental illness;
appropriate treatment of common diseases and injuries; healthcare needs of
the disabled and provision of essential drugs;

   IV.         involves, in addition to the health sector, all related
sectors and aspects of national and community development, in particular
agriculture, trade, food, industry, education, housing, public
infrastructure, communications and information technology and other
sectors; and demands the coordinated efforts of all those sectors;

    V.         requires and promotes maximum community and individual
self-reliance and participation in the planning, organization, operation
and control of primary health care, making fullest use of local, national
and other available resources; and to this end develops through appropriate
training the ability of communities to participate;

   VI.         should be sustained by integrated, functional and mutually
supportive referral systems, leading to the progressive improvement of
comprehensive health care for all, and giving priority to those most in
need;

  VII.         relies, at local and referral levels, on health workers,
including physicians, nurses, midwives, mid-level workers and community
health workers as applicable, as well as traditional practitioners as
needed, suitably trained socially and technically to work as a health team
and to respond to the expressed health needs of the community. All
governments should formulate national policies, strategies and plans of
action to strengthen and sustain primary health care as part of a
comprehensive national health system and in coordination with other
sectors. To this end, it will be necessary to exercise political will, to
mobilize the country's resources and to use available external resources
rationally.



10.  While technology has brought health benefits, care must be taken to
ensure that technology is used with intelligence so that:

                         I.         New bio-technology and artificial
intelligence should be assessed in terms of its potential to do harm as
well as good and in terms of its contribution to overall population health
and equity and be regulated as necessary

                        II.         Over-servicing, especially in the
private sector, requires regulation. One aspect of this which is
contributing to the crisis of anti-microbial resistance is irrational and
overuse of antibiotics in both the health and industrial farming sectors

                       III.         The use of digital technologies has the
potential to increase access and quality of care but strategies must be
informed by an awareness of the digital gradient, which mirrors
socio-economic inequities.  Special measures need to be taken to flatten
this gradient.



11.  An essential component of primary health care is universal health
coverage which should be universalist, based on social solidarity and built
on a unified public funded system, with most service provision through
public institutions.



12.  Since the protection and attainment of health by people in any one
country directly concerns and benefits every other country, development
assistance, including donor programs, must be accountable to and strengthen
national public health systems and address the social, environmental and
ecological determinants of health.



13.  The training of health personnel requires to be more strongly oriented
to primary health care, and employment conditions need to ensure fair and
safe working situations. Distribution of health personnel is grossly
inequitable and reflects the inverse care law. Global and national policies
should institute policies to mitigate the brain drain from low and middle
income countries to high income countries by inter alia increasing
production of their own health workers and compensating sending countries
for their losses in training costs.



14.  Health gains from the implementation of an effective primary health
care system can be easily undermined by the commercial determinants of
health including promotion and trade of health harming commodities (e.g.
food, alcohol, tobacco) and environmentally damaging extractive industries.
Global and national policies, including effective regulation, are needed to
prevent their adverse impacts.



15.  An acceptable level of health for all the people of the world can be
attained through a fuller and better use of the world's resources, a
considerable part of which is now spent on armaments and military
conflicts. A genuine policy of independence, peace, and disarmament could
and should release additional resources that could well be devoted to
peaceful aims and in particular to the acceleration of social and economic
development of which primary health care, as an essential part, should be
allotted its proper share.



We the undersigned representing a wide range of public civil society
organisations and social movement call on the Global Conference on Primary
Health Care to undertake urgent and effective national and global action to
develop and implement primary health care throughout the world and
particularly in low and middle income countries in a spirit of technical
cooperation and in keeping with a sustainable and equitable economic order.
It urges governments, WHO, and other international organizations, as well
as multilateral and bilateral agencies, nongovernmental organizations,
funding agencies, all health workers and the whole world community to
support national and international commitment to primary health care and to
channel increased technical and financial support to it, particularly in
low and middle income countries. We call on all the aforementioned to
collaborate in strengthening, developing, funding and maintaining public
health systems based on primary health care in accordance with the spirit
and content of this Statement.

*Please endorse above statement through this link: *
*https://www.surveymonkey.com/r/5Y6GWCL*
<https://www.surveymonkey.com/r/5Y6GWCL>
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